NPIMap

Organization Active NPI

Pinnacle Oral & Maxillofacial Surgery Associates Inc

  • Oral and Maxillofacial Surgery (Dentist)
  • Clarks Summit, PA
National Provider Identifier
1851505689
Registry record updated Mar 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
PINNACLE ORAL & MAXILLOFACIAL SURGERY ASSOCIATES INC
Practice address
233 Northern Blvd
Suite 5
Clarks Summit, PA 18411-8720
Phone
(570) 586-5300
Fax
(570) 586-4720
NPI assigned
May 10, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Kenneth G Miller, DDSNPI 1255419305
Title
President
Phone
(570) 586-5300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193200000X MULTI-SPECIALTY GROUP 1223S0112X Primary

Addresses

Primary practice location

233 Northern Blvd
Suite 5
Clarks Summit, PA 18411-8720

Mailing address

233 Northern Blvd
Suite 5
Clarks Summit, PA 18411-8720
Phone (570) 586-5300

Other identifiers 1

IdentifierTypeStateIssuer
000938910MedicaidPA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363910400000",
    "number": "1851505689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "233 NORTHERN BLVD",
            "address_2": "SUITE 5",
            "city": "CLARKS SUMMIT",
            "state": "PA",
            "postal_code": "184118720",
            "telephone_number": "570-586-5300",
            "fax_number": "570-586-4720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "233 NORTHERN BLVD",
            "address_2": "SUITE 5",
            "city": "CLARKS SUMMIT",
            "state": "PA",
            "postal_code": "184118720",
            "telephone_number": "570-586-5300",
            "fax_number": "570-586-4720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINNACLE ORAL & MAXILLOFACIAL SURGERY ASSOCIATES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-10",
        "last_updated": "2013-03-22",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "570-586-5300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000938910",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarks Summit, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.